Epileptogenic Tubers Are Associated with Increased Kurtosis of Susceptibility Values: A Combined Quantitative Susceptibility Mapping and Stereoelectroencephalography Pilot Study.
- Resource Type
- Academic Journal
- Authors
- Chari A; From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health Aswin.chari.18@ucl.ac.uk.; Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.).; Sedlacik J; Neuroradiology (J.S., P.H., K.M., U.L.).; Seunarine K; From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health.; Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.).; Piper RJ; From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health.; Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.).; Hales P; Neuroradiology (J.S., P.H., K.M., U.L.).; Shmueli K; Department of Medical Physics and Bioengineering (K. Shmueli), University College London, London, UK.; Mankad K; Neuroradiology (J.S., P.H., K.M., U.L.).; Löbel U; Neuroradiology (J.S., P.H., K.M., U.L.).; Eltze C; Neurology (C.E., R.C.S., J.H.C.).; Moeller F; Neurophysiology (F.M.), Great Ormond Street Hospital, London, UK.; Scott RC; Neurology (C.E., R.C.S., J.H.C.).; Department of Pediatric Neurology (R.C.S.), Nemours Children's Hospital, Wilmington, Delaware.; Tisdall MM; From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health.; Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.).; Cross JH; From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health.; Neurology (C.E., R.C.S., J.H.C.).; Carmichael DW; Engineering and Physical Sciences Research Council/Wellcome Centre for Medical Engineering and Department of Biomedical Engineering (D.W.C.), School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Source
- Publisher: American Society of Neuroradiology Country of Publication: United States NLM ID: 8003708 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1936-959X (Electronic) Linking ISSN: 01956108 NLM ISO Abbreviation: AJNR Am J Neuroradiol Subsets: MEDLINE
- Subject
- Language
- English
Background and Purpose: Prior studies have found an association between calcification and the epileptogenicity of tubers in tuberous sclerosis complex. Quantitative susceptibility mapping is a novel tool sensitive to magnetic susceptibility alterations due to tissue calcification. We assessed the utility of quantitative susceptibility mapping in identifying putative epileptogenic tubers in tuberous sclerosis complex using stereoelectroencephalography data as ground truth.
Materials and Methods: We studied patients with tuberous sclerosis complex undergoing stereoelectroencephalography at a single center who had multiecho gradient-echo sequences available. Quantitative susceptibility mapping and R2* values were extracted for all tubers on the basis of manually drawn 3D ROIs using T1- and T2-FLAIR sequences. Characteristics of quantitative susceptibility mapping and R2* distributions from implanted tubers were compared using binary logistic generalized estimating equation models designed to identify ictal (involved in seizure onset) and interictal (persistent interictal epileptiform activity) tubers. These models were then applied to the unimplanted tubers to identify potential ictal and interictal tubers that were not sampled by stereoelectroencephalography.
Results: A total of 146 tubers were identified in 10 patients, 76 of which were sampled using stereoelectroencephalography. Increased kurtosis of the tuber quantitative susceptibility mapping values was associated with epileptogenicity ( P = .04 for the ictal group and P = .005 for the interictal group) by the generalized estimating equation model. Both groups had poor sensitivity (35.0% and 44.1%, respectively) but high specificity (94.6% and 78.6%, respectively).
Conclusions: Our finding of increased kurtosis of quantitative susceptibility mapping values (heavy-tailed distribution) was highly specific, suggesting that it may be a useful biomarker to identify putative epileptogenic tubers in tuberous sclerosis complex. This finding motivates the investigation of underlying tuber mineralization and other properties driving kurtosis changes in quantitative susceptibility mapping values.
(© 2023 by American Journal of Neuroradiology.)